Surgical operation system

ABSTRACT

A surgical operation system includes a US signal output section, an HV signal output section, a probe having a treatment section which has an HV signal applied thereto and vibrates by ultrasound, an HV signal main controller that performs feedback control of the HV signal output section based on the HV signal, a US signal main controller that performs feedback control of the US signal output section based on a US signal, and an HV signal auxiliary controller that controls the HV signal output section based on the US signal, and has a response time shorter than that of the HV signal main controller.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation application of U.S. Ser. No.13/791,933 filed on Mar. 9, 2013, issued as U.S. Pat. No. 9,878,183,which is a continuation application of PCT/JP2012/070891 filed on Aug.17, 2012 and claims benefit of U.S. Provisional Patent Application Nos.61/536,779 filed in the U.S.A. on Sep. 20, 2011, 61/536,796 filed in theU.S.A. on Sep. 20, 2011, 61/536,818 filed in the U.S.A. on Sep. 20,2011, the entire contents of each of which are incorporated herein byreference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates to a surgical operation system including ahandpiece to which ultrasound energy and high-frequency energy aresimultaneously applied.

2. Description of the Related Art

In a surgical operation, a monopolar type handpiece using ahigh-frequency current is used when cutting or coagulation of livingtissue is performed. A cutting mode in which cutting is performed, and acoagulation mode in which coagulation is performed are switched by awaveform of the high-frequency current which is applied to a treatmentsection 9 of the handpiece. In the cutting mode, a high-frequencycurrent (high-frequency energy) of a continuous waveform is applied, andliving tissue is transpired by large heat generation. In the coagulationmode, a high-frequency current of an interrupted wave (burst wave) isapplied, and thereby living tissue is kept at a temperature at whichprotein and the like are coagulated. In a blend mode in which ahigh-frequency current of a current waveform with the continuouswaveform and the burst waveform being blended, bleeding can be stoppedwhile living tissue is cut.

Japanese Patent Application Laid-Open Publication No. 2002-306507discloses that living tissue is prevented from being burnt onto thetreatment section 9 by application of not only a high-frequency currentbut also ultrasound vibration to the treatment section 9.

Further, Japanese Patent Application Laid-Open Publication No. 2010-5370discloses a surgical operation system which detects ultrasound impedancecorresponding to the ultrasound vibration of the treatment section 9 towhich a high-frequency current and ultrasound vibration are applied, andcontrols the high-frequency current.

Here, the effect of the conventional surgical operation system includingthe handpiece to which a high-frequency current and ultrasound vibrationare applied is only simple addition of the effect obtained byapplication of only the high-frequency current and the effect obtainedby application of only the ultrasound vibration.

SUMMARY OF THE INVENTION

A surgical operation system of an embodiment includes a drive signaloutput section that outputs a drive signal, a high-frequency signaloutput section that outputs a high-frequency signal, a probe having atreatment section with the high-frequency signal being applied thereto,that vibrates by ultrasound that an ultrasound transducer generates bythe drive signal, and performs a bleeding stopping process while makingan incision line in a pressing direction, when the probe is pressedagainst a parenchyma organ by a synergetic effect of the drive signaland the high-frequency signal, a counter electrode plate that forms areturn circuit of the high-frequency signal, a high-frequency signalmain control section that performs feedback control of thehigh-frequency signal output section, based on the high-frequencysignal, a drive signal main control section that performs feedbackcontrol of the drive signal output section, based on the drive signal, ahigh-frequency signal auxiliary control section that controls thehigh-frequency signal output section to stop output of thehigh-frequency signal based on the drive signal, and has a response timeshorter than that of the high-frequency signal main control section.

A surgical operation system of another embodiment includes a treatmentsection that is a treatment section that simultaneously performs ahigh-frequency treatment and an ultrasound treatment on tissue, andperforms a bleeding stopping process while making an incision line onthe tissue, a drive signal output section that outputs a drive signalfor the ultrasound treatment to the treatment section, a drive signaldetection section that detects a parameter of the drive signal which thedrive signal output section outputs, a drive signal main control sectionthat performs feedback control of the drive signal output section basedon the parameter which is detected in the drive signal detectionsection, a high-frequency signal output section that outputs ahigh-frequency signal for the high-frequency treatment to the treatmentsection, a high-frequency signal detection section that detects aparameter of the high-frequency signal which the high-frequency signaloutput section outputs, a drive signal main control section thatperforms feedback control of the high-frequency signal output sectionbased on the parameter which is detected in the high-frequency signaldetection section, a high-frequency signal auxiliary control sectionthat determines whether or not the treatment section separates from thetissue based on the parameter detected in the drive signal detectionsection, and controls the high-frequency signal output section to stopoutput of the high-frequency signal when the high-frequency signalauxiliary control section determines that the treatment sectionseparates from the tissue, and has a response time shorter than that ofthe high-frequency signal main control section, and a recovery sectionthat forms a return circuit of the high-frequency signal outputted tothe treatment section.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view showing an entire configuration of asurgical operation system of a first embodiment;

FIG. 2 is a sectional view showing an internal configuration of ahandpiece of the surgical operation system of the first embodiment;

FIG. 3 is a configuration diagram showing a configuration of a surgicaloperation system of the first embodiment;

FIG. 4A is an explanatory diagram for explaining a high-frequency signalof a cutting waveform;

FIG. 4B is an explanatory diagram for explaining a high-frequency signalof a coagulation waveform;

FIG. 5 is a configuration diagram showing a configuration of a signaldetection section of the surgical operation system of the firstembodiment;

FIG. 6 is a perspective view for explaining processing of making anincision line according to the surgical operation system of the firstembodiment;

FIG. 7A is a schematic sectional view of a treatment section forexplaining a treatment in a case of only HV energy being applied;

FIG. 7B is a schematic sectional view of the treatment section forexplaining a treatment in a case of the HV energy and US energy beingapplied;

FIG. 8 is a flowchart for explaining a flow of processing of thesurgical operation system of the first embodiment;

FIG. 9 is a frequency spectrum diagram for explaining signals of thesurgical operation system of the first embodiment;

FIG. 10A is a frequency spectrum diagram for explaining the signal ofthe surgical operation system of the first embodiment;

FIG. 10B is a frequency spectrum diagram for explaining the signal ofthe surgical operation system of the first embodiment;

FIG. 11 is a configuration diagram for explaining a configurationexample of the surgical operation system of the first embodiment;

FIG. 12 is a graph showing one example of an influence that applicationof a load to the treatment section exerts on a phase difference of acurrent and a voltage, in the surgical operation system of the firstembodiment;

FIG. 13 is a configuration diagram showing a configuration of a surgicaloperation system of a modification of the first embodiment;

FIG. 14 is a configuration diagram showing a configuration of a surgicaloperation system of a second embodiment;

FIG. 15 is a configuration diagram showing a configuration of a signaldetection section of the surgical operation system of the secondembodiment;

FIG. 16 is a flowchart for explaining a flow of processing of thesurgical operation system of the second embodiment;

FIG. 17 is a configuration diagram showing a configuration of a surgicaloperation system of a modification of the second embodiment;

FIG. 18 is a configuration diagram showing a configuration of a surgicaloperation system of a third embodiment;

FIG. 19 is a flowchart for explaining a flow of processing of thesurgical operation system of the third embodiment; and

FIG. 20 is a configuration diagram showing a configuration of a surgicaloperation system of a modification of the third embodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS First Embodiment

Hereinafter, a surgical operation system 1 of a first embodiment of thepresent invention will be described with reference to the drawings. Asshown in FIG. 1, the surgical operation system 1 includes a handpiece 2,an ultrasound transducer drive signal generating apparatus (hereinafter,called “US apparatus”) 5, a high-frequency current signal generatingapparatus (hereinafter, called “HV apparatus”) 6, and a counterelectrode plate 3 as a recovery section. Note that the US apparatus 5and the HV apparatus 6 may be a signal generating apparatus 10 in whichthe US apparatus 5 and the HV apparatus 6 are housed in one casing andshare some functions.

Outline of the Surgical Operation System

The monopolar type handpiece 2 is a surgical treatment instrument havinga treatment section 9 at a distal end. The US apparatus 5 generates adrive signal (hereinafter, called “US signal”) that drives an ultrasoundtransducer 23 (see FIG. 2) contained in the handpiece 2. The HVapparatus 6 supplies a high-frequency signal (hereinafter, called “HVsignal”) to the handpiece 2. As will be described later, the counterelectrode plate 3 that is the recovery section is disposed to be incontact with a hip or the like of a patient in a large area, and forms areturn circuit of the HV signal.

The handpiece 2 has a grasping portion 7 for a surgeon to grasp, a shaftportion 8 that protrudes forward from the grasping portion 7, and atreatment section 9 placed at a distal end of the shaft portion 8. Onthe grasping portion 7, a selection switch 11 (11 a, 11 b, 11 c) forperforming selection or the like of a treatment that is performed withthe treatment section 9 is placed.

From a rear end side of the grasping portion 7 of the handpiece 2, a UScable 13, a hand switch cable 14, and an HV cable 15 are extended. Inthe US cable 13 and the hand switch cable 14, connectors at end portionsthereof are detachably connected to the US apparatus 5. In the HV cable15, a connector at an end portion thereof is detachably connected to theHV apparatus 6. To the HV apparatus 6, a connector of an end portion ofa counter electrode plate cable 16 that is connected to the counterelectrode plate 3 is also detachably connected. The US apparatus 5 andthe HV apparatus 6 perform transmission and reception of signals via acommunication cable 17 which is connected thereto. Further, the USapparatus 5 and the HV apparatus 6 respectively have front panels 18 and19 for performing display and operation input. The US apparatus 5 andthe HV apparatus 6 may be operable by foot switches or the like.

As shown in FIG. 2, in the handpiece 2, a housing portion is configuredby a substantially cylindrical main case 21 that configures the graspingportion 7, and a secondary case 22 connected to an end portion thereof.Inside the main case 21, the ultrasound transducer (US transducer) 23connected to the US cable 13 is disposed.

The ultrasound transducer 23 includes a plurality of ring-shapedelectrostrictive elements 24 that are fastened by a bolt 25 and a nut26. When the US signal is applied to electrodes that are provided onrespective surfaces of the electrostrictive elements 24, the ultrasoundtransducer 23 performs ultrasound vibration. The ultrasound vibration istransmitted to the treatment section 9 through the shaft portion 8 thatis configured by a horn 27 connected to a front end of the ultrasoundtransducer 23 (bolt 25) and a probe 28. Note that the probe 28 isinserted through an inside of a metallic pipe 30 that is covered with aninsulating pipe 29.

The nut 26 is made of a metal, and is also a conductive portion to whicha conductor wire of the HV cable 15 is connected. The HV signal that isapplied to the nut 26 is transmitted to the treatment section 9 made ofa metal through the bolt 25 made of a metal and the probe 28 made of ametal.

Configuration of the Surgical Operation System

Next, a configuration of the surgical operation system 1 will bedescribed with use of FIG. 3. A surgeon performs processing of making anincision line on an organ 41 of a patient 40 with use of the treatmentsection 9 of the handpiece 2 of the surgical operation system 1.

The US apparatus 5 which generates a US signal to supply ultrasound (US)energy to the treatment section 9 has a central processing unit (CPU)51, a US signal detection section 52, an A/D conversion section 53, anoutput transformer 54, an amplifier 55, a waveform generating section56, a PLL section 57 and a power supply 58. The output transformer 54,the amplifier 55, the waveform generating section 56, the PLL section 57and the power supply 58 configure a drive signal output section (USsignal output section) 50. The US signal is, for example, an AC signalof a sine wave of a predetermined fundamental frequency (resonancefrequency).

The CPU 51 which performs control of the entire US apparatus 5 has adrive signal calculating section (US signal calculating section) 51 a, adrive signal main control section (US signal main control section) 51 cand a high-frequency signal auxiliary control section (HV signalauxiliary control section) 51 b. Note that the US signal calculatingsection 51 a, the US signal main control section 51 c and the HV signalauxiliary control section 51 b may be respectively configured bydifferent CPUs.

The waveform generating section 56 generates, for example, a sine-wavesignal. The sine-wave signal generated by the waveform generatingsection 56 is amplified in the amplifier 55, thereafter is applied to aprimary winding side of the output transformer 54, and is applied to theultrasound transducer 23 of the handpiece 2 as the US signal from anoutput terminal at a secondary winding side of the output transformer54.

A US signal intensity, that is, the ultrasound output of the ultrasoundtransducer 23 is regulated in accordance with an output voltage of thepower supply 58. The output voltage of the power supply 58, that is, theultrasound output and an operation of the waveform generating section 56are controlled by the US signal main control section 51 c.

The US signal main control section 51 c controls the output voltage andthe like of the power supply 58 so as to produce ultrasound outputcorresponding to a setting operation based on the US signal (parameter)which the US signal detection section 52 detects, in response to thesetting operation by a setting section 18 a or the like of the frontpanel 18. The front panel 18 is provided with a display section 18 bthat displays information such as the US signal intensity which isoutputted from the CPU 51. Namely, the US signal main control section 51c performs feedback control.

Further, the sine-wave signal amplified by the amplifier 55 is inputtedin a current (I) detection section 52 a and a voltage (V) detectionsection 52 b that configure the US signal detection section 52. Further,the sine-wave signal is inputted in the PLL section 57.

The PLL section 57 performs PLL control of the ultrasound transducer 23so as to cause the ultrasound transducer 23 to drive by the US signal ofthe resonance frequency. Further, the PLL section 57 performs control sothat a phase of the voltage of the US signal becomes the same phase as aphase of the current. An operation of the PLL section 57 is controlledby the US signal main control section 51 c.

The US current signal detection section 52 a and the US signal voltagedetection section 52 b converts the sine-wave signal amplified by theamplifier 55 into a root mean square value (RMS). A root mean squarevalue of the voltage and a root mean square value of the current arerespectively converted into digital signals by the A/D conversionsection 53 (53 a, 53 b), and are inputted in the CPU 51. The US signalcalculating section 51 a calculates a US signal intensity (US signaloutput) with use of a digital signal of the voltage root mean squarevalue or the current root mean square value which is inputted.

The HV apparatus 6 which generates an HV signal and supplieshigh-frequency (HV) energy to the treatment section 9 has a centralprocessing unit (CPU) 61, an HV signal detection section 62, an A/Dconversion section 63, an output transformer 64, an amplifier 65, awaveform generating section 66, a resonance section 67, a power supply68, and a high-frequency signal relay (HV signal relay) 69. Theamplifier 65, the waveform generating section 66, the resonance section67, the power supply 68 and the HV signal relay 69 configure ahigh-frequency signal output section (HV signal output section) 60. TheHV signal is, for example, an AC signal of a sine wave of apredetermined fundamental frequency.

The HV signal relay 69 is a switch that turns on/off the output of asignal received from the power supply 68 to a post-stage circuit. Thatis to say, the HV signal relay 69 outputs a signal to the post-stagecircuit in an ON state (continuity state), but does not output a signalto the post-stage circuit in an OFF state (open state).

The CPU 61 which performs control of the entire HV apparatus 6 has ahigh-frequency signal calculating section (HV signal calculatingsection) 61 a and a high-frequency signal main control section (HVsignal main control section) 61 c. Note that the HV signal calculatingsection 61 a and the HV signal main control section 61 c may berespectively configured by different CPUs. Further, the CPU 61 may bethe same CPU as the CPU 51.

The waveform generating section 66 generates at least a coagulationwaveform signal. Whereas the cutting waveform signal of a continuouswaveform including a continuous sine wave signal shown in FIG. 4A, thecoagulation waveform signal shown in FIG. 4B is an interrupted wave, inwhich a burst wave is repeated, which has one cycle configured by anattenuating sine-wave signal time period (Ton) in which a maximum value(amplitude) is gradually decreasing, and a signal stopping time period(Toff).

The signal which is outputted from the waveform generating section 66 isinputted in the amplifier 65 via the resonance section 67. The signalamplified by the amplifier 65 is applied to a primary winding side ofthe output transformer 64, and an HV signal is generated at a secondarywinding side.

One end of the secondary winding of the output transformer 64 iscontinued to the horn 27 and the like of the handpiece 2. Further, theother end of the secondary winding is continued to the counter electrodeplate 3 which is in contact with the patient 40 in a wide area.

Further, the resonance section 67 is supplied with electric power fromthe power supply 68 with a variable voltage. The waveform generatingsection 66 and the power supply 68 are controlled by the HV signal maincontrol section 61 c.

The HV signal main control section 61 ccontrols an output voltage of thepower supply 68 and regulates HV signal output, based on the HV signal(parameter) which the HV signal detection section 62 detects, inresponse to a setting operation by a setting section 19 a or the like ofthe front panel 19. That is to say, the HV signal main control section61 c performs feedback control. Note that the CPU 61 also can variablycontrol a crest factor CF by changing an amplitude, and an attenuationpattern of the sine wave configuring the coagulation waveform and/or thesignal stopping time period (Toff) in the case of coagulation waveformsignal generation. The crest factor (CF: crest factor) is maximum value(Imax)/root mean square value (RMS), and for example, in a continuoussine wave, CF=1.4.

The front panel 19 is provided with a display section 19 b that displaysinformation of the HV signal. The signal amplified by the amplifier 65is inputted in a current (I) detection section 62 a and a voltage (V)detection section 62 b that configure the HV signal detection section62. The HV signal detection section 62 converts the signal which isamplified by the amplifier 65 into a root mean square value. The rootmean square value of the voltage and the root mean square value of thecurrent are respectively converted into digital signals by the A/Dconversion section 63 (63 a, 63 b), and are inputted in the CPU 61.

The HV signal calculating section 61 a calculates HV signal output byusing the inputted digital signal of the voltage root mean square valueor the current root mean square value.

The feedback control which is ordinary control performed by the USsignal main control section 61 c and the HV signal main control section51 c is control for keeping, for example, a signal intensity at apredetermined intensity. In contrast with this, the HV signal auxiliarycontrol section 51 b controls the HV signal relay 69 of the HV signaloutput section 60 into an ON state or an OFF state, based on the USsignal detected by the US signal detection section 52. That is to say,the control which is performed by the HV signal auxiliary controlsection 51 b is ON/Off control that only stops output of a signal, andtherefore, high-speed control with a short response time can be realizedrelatively easily as compared with the ordinary control that increasesand decreases output.

Here, in the treatment (an ultrasound treatment and a high-frequencytreatment) that is performed by ultrasound vibration and ahigh-frequency current being simultaneously applied to the treatmentsection, there is the fear of occurrence of a spark discharge(hereinafter, called “high-energy discharge”) with large energy thathardly occurs in the treatment (high-frequency treatment) which isperformed only a high-frequency current being applied to the treatmentsection.

For example, when the treatment section 9 separates from the tissueincluding fat which the treatment section 9 treats, a high-energydischarge is likely to occur to accelerate deterioration of thetreatment section 9.

Therefore, the conventional surgical operation system in whichultrasound vibration and a high-frequency current are simultaneouslyapplied to the treatment section needs to be operated by a surgeon withscrupulous care, and cannot be always said as favorable in operability.

Further, in the surgical operation system 1, when the HV signalauxiliary control section 51 b senses that the treatment section 9separates from tissue, based on the US signal detected by the US signaldetection section 52, the HV signal auxiliary control section 51 bcontrols the HV signal relay 69 of the HV signal output section 60 intoan OFF state. Namely, after an extremely short time period afterdetection of the US signal, application of the HV signal to thetreatment section 9 stops. Therefore, even when the treatment section 9separates from the tissue, a high-energy discharge does not occur.

It is conceivable that immediately before a high-energy dischargeoccurs, a discharge that has a small intensity, but differs from anordinary discharge occurs as a precursory phenomenon thereof. The HVsignal auxiliary control section 51 b stops output before a high-energydischarge occurs based on the signal change due to the precursoryphenomenon or the like, and thereby prevents occurrence of thehigh-energy discharge.

Namely, in a strict sense, “when the treatment section 9 separates fromtissue” does not mean “when the treatment section 9 completelyseparates”, but rather means “when the treatment section 9 starts toseparate”.

In addition, the HV signal auxiliary control section 51 b has a responsetime shorter than the HV signal main control section 51 c. Namely,response times of the US signal main control section 51 c and the HVsignal main control section 61 c which perform feedback control arepreferably 5 ms (milliseconds) or longer, and, for example, 100 ms.

In contrast with this, the response time of the HV signal auxiliarycontrol section 51 bis preferably 1 ms or less, and, for example, 0.5ms. Further, the HV signal relay 69 is also the circuit of a simpleoperation that is an ON/Off operation, and therefore, a response timethereof is 1 ms or less, and is, for example, 0.2 ms. The HV signalrelay 69 may be a mechanical type switch, or a semiconductor switch.

Note that if the response time is 1 ms or less, an attenuation sectionthat reduces signal output to substantially zero, namely, reduces asignal intensity to such an intensity that does not influence atreatment or the like may be used in place of the relay type ON/OFFswitch. For example, when the amplifier 65 is controllable at a highspeed, the function of the attenuation section may be realized bycontrol of the amplifier 65. Namely, in the following description andthe like, “stops signal output” is the concept also including the caseof “reducing signal output to substantially zero”. For example, if thevoltage is 200 Vp or less in the HV signal, a medical effect is notexhibited in living tissue, and a high-energy discharge does not occur.However, a relay is the most preferably used, because the relay is aless expensive switch with a high response speed.

Note that the US signal detection section 52 detects signals atintervals of 1 ms or less. The HV signal auxiliary control section 51 bsequentially processes the signals which the US signal detection section52 detects at intervals of 1 ms or less, but the US signal main controlsection 51 c processes the signals which the US signal detection section52 detects at predetermined intervals longer than the detectionintervals of the US signal detection section 52, for example, atintervals of 100 ms. The US signal main control section 51 c may performcontrol with use of an integrated value or a mean value of the signalswhich the US signal detection section 52 detects at intervals of 1 ms orless.

The HV signal main control section 61 c processes the signal which theHV signal detection section 62 detects at intervals of 100 ms, forexample.

Note that as shown in FIG. 5, the US signal detection section 52 mayhave a US signal main detection section 52A and a US signal auxiliarydetection section 52B. Further, the US signal detected by the US signalmain detection section 52A and the US signal detected by the US signalauxiliary detection section 52B may be sampled from the same spot on thecircuit, or may be sampled from different spots.

The US signal auxiliary detection section 52B has detection intervalsshorter than the US signal main detection section 52A. For example,whereas the US signal main detection section 52A detects signals atintervals of 5 ms or more, for example, intervals of 100 ms, the USsignal auxiliary detection section 52B detects signals at intervals of 1ms or less, for example, intervals of 0.5 ms.

Subsequently, the HV signal main control section 61 c performs ordinaryfeedback control based on the signal detected by a HV signal maindetection section 62A, and the HV signal auxiliary control section 51 bperforms high-speed control with a high response speed based on thesignal which the US signal auxiliary detection section 52B detects.Further, the US signal main control section 51 c performs ordinaryfeedback control based on the signal which the US signal main detectionsection 52A detects.

The US signal main control section 51 c and the HV signal main controlsection 61 c can stably perform control if a loop processing time periodof detection/response is in the aforementioned range or more. Namely, ifthe detection interval and the response time are too short in control offeedback, signal output is sometimes excessively increased in responseto a noise signal which appears in a pulse form, for example. Therefore,the signal detection intervals and the response times of the US signalmain control section 51 c and the HV signal main control section 61 care preferably in the aforementioned range or more.

In contrast with this, the HV signal auxiliary control section 51 bneeds to stop output of the HV signal before a high-energy dischargeoccurs, when the treatment section 9 contacts other instruments made ofmetal.

Therefore, the time period from detection of a US signal until anoperation of the HV signal relay 69 is completed by control of the HVsignal auxiliary control section 51 b is preferably 1 ms or less.

If the time period is the above described time period or less,occurrence of a high-energy discharge can be reliably prevented.

Note that the above described detection intervals, the above describedresponse time and the time period until operation completion arepreferably short, but in industrially available systems, approximately1μ (microsecond) is a lower limit value.

Treatment by the Surgical Operation System

At a time of a treatment, the US signal subjected to feedback control bythe US signal main control section 51 c is applied to the ultrasoundtransducer 23, and the treatment section 9 performs ultrasoundvibration. Subsequently, when the treatment section 9 comes into contactwith or comes close to the organ 41 of a treatment target of the patient40, the HV signal (high-frequency current) which is subjected tofeedback control by the HV signal main control section 61 c flows fromthe treatment section 9 to the organ 41. Subsequently, the HV signalwhich flows into the organ 41 returns to the HV apparatus 6 through aninside of a body of the patient 40, the counter electrode plate 3, andthe counter electrode plate cable 16.

The HV energy is applied to the treatment target as Joule heat due tocontact resistance and the like of the treatment section 9 and the organ41, or heat and shock waves due to a discharge phenomenon between thetreatment section 9 and the organ 41.

Note that the above described components do not have to be thecomponents (circuits and the like) which are respectively independent,and may be function sections which the CPUs 51 and 61 execute by readprograms.

Next, a treatment by the surgical operation system 1 will be described.As shown in FIG. 6, in the surgical operation system 1, a surgeonperforms operation of pressing the treatment section 9 to the organ 41which is a parenchyma organ while simultaneously applying the HV signaland the US signal to the treatment section 9 of the handpiece 2, andthereby can stop bleeding while the surgeon makes an incision line 42 ina pressing direction.

In contrast with this, in the conventional surgical operation system, itis not easy to stop bleeding while making an incision line on aparenchyma organ having a number of blood vessels therein, for example,a liver, even in the blend mode, and operability cannot be always saidas favorable.

Here, “parenchyma organ” refers to tissue in a living body, for example,an organ such as a liver. Further, the medical term “cut” includes threetreatments that are “excision”, “exfoliation” and “making an incisionline”.

“Excision” of a polyp or the like or “exfoliation” of a diaphragm or thelike corresponds to cutting that cuts off tissue, and therefore, energycan be concentrated into a spot to be cut by the tissue to be cut beingsandwiched and grasped. For example, with a handpiece having a jaw thatsandwiches and grasps tissue in cooperation with a probe distal endportion to which only ultrasound energy is applied, cutting can beperformed on the grasped tissue by mechanical friction force by the USenergy and heat generation by the friction. Further, with a bipolar typehandpiece that passes the HV signal applied to the distal end portion tothe jaw which is a counter electrode, cutting can be performed for thegrasped tissue without application of the US energy. However, thehandpiece which grasps tissue by sandwiching the tissue cannot perform“treatment of making an incision line”.

Note that as already described, the conventional HV apparatus can stopbleeding while cutting in the blend mode. However, this is for tissue orthe like of a body surface that hardly bleeds, and sufficient stoppageof bleeding is not easy with organs having a large number of bloodvessels therein such as a liver.

Further, with the monopolar type (monopole type) handpiece 2, a pressingforce is not so strong as the grasping force by a bipolar type handpieceeven if the treatment section 9 which performs ultrasound vibration ispressed against tissue. Therefore, heat generation by friction force andfriction is small, and tissue cannot be cut mechanically or thermally.Further, the heat generation of the treatment section 9 to which onlythe HV signal (HV energy) of a coagulation waveform is applied isinsufficient, and the treatment section 9 cannot transpire livingtissue, and cannot make an incision line.

In contrast with this, in the surgical operation system 1, instead ofthe effect which is a simple combination of the effect obtained byapplication of only a high-frequency current and the effect obtained byapplication of only ultrasound vibration, an effect that is not lessthan the sum of the effects which are individually brought about byapplication of the high frequency current and application of ultrasoundvibration, namely, a synergistic effect can be obtained. As a matter ofcourse, it is extremely difficult to predict such a synergistic effect.

In order to obtain the above described synergistic effect in thesurgical operation system 1, it is important that the HV signal has acoagulation waveform, first of all. As is already described, with onlythe HV signal of a coagulation waveform, living tissue cannot betranspired. However, as shown in FIG. 6, in the surgical operationsystem 1, the HV signal of a coagulation waveform is applied to thetreatment section 9 together with the US signal, whereby bleeding can bestopped while an incision line is made on a liver in the pressingdirection of the treatment section 9.

As shown in FIG. 7A, in a state in which ultrasound vibration is notapplied, namely, in a state in which only the HV signal is applied, theHV signal of the coagulation waveform from the treatment section 9isotropically flows to the surrounding tissue, even if the surgeonoperates and presses the treatment section 9 in an intended direction ofthe organ 41. For example, many discharges by the HV signal occur notonly to the pressing direction of the treatment section 9 but also tothe direction orthogonal to the pressing direction, and the like.Therefore, as shown in FIG. 7A, large heat generation does not locallyoccur, and tissue 43 that is coagulated by thermal denaturation, and hashigh impedance with moisture vaporized is formed around the treatmentsection 9.

When the treatment section 9 which performs ultrasound vibration and hasthe HV signal applied thereto is operated and pressed in a predetermineddirection, as shown in FIG. 7B, the HV signal with the coagulationwaveform from the treatment section 9 intensively flows to the tissue inthe pressing direction. In other words, discharges by the HV signal withthe coagulation waveform concentrates into a space between the treatmentsection 9 and the tissue in the pressing direction. Namely, polarityoccurs to the discharge by the HV signal. Therefore, even with the HVsignal of the coagulation waveform, the pressed tissue is transpired bylarge heat generation, and the incision line 42 is made in the pressingdirection.

When the treatment section 9 advances and moves in the cut tissue bypressing operation, a wall surface (cut surface) of the tissue locatedin the direction orthogonal to a traveling direction of the treatmentsection 9 has a long distance from the treatment section 9, andtherefore, the HV signal does not concentrate on the wall surface somuch as compared with the traveling direction. Therefore, the cutsurface has a temperature suitable for coagulation, has moisturevaporized, and is increased in impedance. Therefore, whereas the tissuein the pressing direction of the treatment section 9, that is, in thetraveling direction transpires, bleeding of the tissue of the cutsurface which the treatment section 9 passes is stopped.

Note that the cause of occurrence of polarity in the discharge by the HVsignal is conceivable as follows.

(A) The HV signal concentrates into a low impedance region of aparenchyma organ generated by the ultrasound vibration of the treatmentsection 9. Namely, when the treatment section 9 which performsultrasound vibration and has the HV signal applied thereto is operatedand pressed in a predetermined direction, only a region that is pressedof the parenchyma organ increased in impedance around the treatmentsection 9 is physically exfoliated by the ultrasound vibration. Thereby,the parenchyma organ with a high moisture content is exposed to asurface. In other words, by the effect of pushing a side incised organby the ultrasound vibration, low impedance tissue appears in the pushingdirection. Thereupon, the HV signal applied to the treatment section 9locally concentrates into the low impedance tissue with a high moisturecontent. Therefore, polarity occurs to the discharge by the HV signal.

(B) The treatment section 9 is repeatedly brought into a contact stateand a non-contact state with the tissue in the pressing direction inaccordance with the ultrasound vibration. Namely, when the treatmentsection 9 which performs ultrasound vibration is operated and pressed,the distance between the treatment section 9 and the tissue in thepressing direction varies. Further, at the moment when the treatmentsection 9 comes to be not in contact with the tissue, an atmosphericpressure of a space between the treatment section 9 and the tissuebecomes low. In contrast with this, at the moment when the treatmentsection 9 comes into contact with the tissue, the atmospheric pressureof the space between the treatment section 9 and the tissue becomeshigh. Namely, in response to the ultrasound vibration of the treatmentsection 9, the pressure of the space between the treatment section 9 andthe tissue in the pressing direction varies. In this manner, thedistance between the treatment section 9 and the parenchyma organcontinues to vary in a range of, for example, 0 to 200 μm by theultrasound vibration, and thereby, a state (distance, pressure) in whicha discharge easily occurs is brought about during variation. Therefore,the HV signal which is applied to the treatment section 9 locallyconcentrates into the tissue in the pressing direction. Therefore,anisotropy occurs in the discharge direction.

(C) The HV signal concentrates along a path where particles formed fromcomponents (moisture and oil components, and moisture and oil mixturecomponents) dispersed from a parenchyma organ due to ultrasoundvibration are present. Namely, when the treatment section 9 whichperforms ultrasound vibration is operated and pressed, the tissue iscrushed by the ultrasound vibration, is further atomized, and becomesparticles to be suspended in a space. The moisture configuring thetissue becomes water vapor particles, and the oil components configuringthe tissue becomes oil particles. The mixture particles includingmoisture and oil components are also generated. Therefore, in the spacebetween the treatment section 9 and the tissue, the particles includingthe components dispersed from the tissue are unevenly distributed.Therefore, the HV signal concentrates along the path where the particlesincluding the components which are dispersed from the tissue arepresent. Accordingly, polarity occurs to the discharge by the HV signal.

Note that in the surgical operation system of the present embodiment, ifthe HV signal which is applied simultaneously with the US signal has acoagulation waveform, the effect is provided, and 30 W to 70 W inclusiveis especially preferable. With the aforementioned lower limit or more,an incision line can be made in the pressing direction by the HV signalconcentrating into the electrode portion, and with the aforementionedupper limit or less, the tissue which the treatment section 9 passes iscoagulated and bleeding can be stopped. Further, the crest factor CF ofthe coagulation waveform of the HV signal is preferably 5 or more, morepreferably 5.5 or more, and especially preferably 6 or more. If thecrest factor CF is the above described lower limit or more, an incisionline can be made in the pressing direction by the HV signal concentratedin the electrode portion, and the tissue which the treatment section 9passes is coagulated and bleeding can be stopped. Further, the upperlimit value of the crest factor CF is not especially limited, but ispreferably 10 or less, for example, from the specifications and the likeof the HV apparatus.

The vibration speed of the ultrasound vibration of the treatment section9 by the US signal is preferably 8 m/sec to 18 m/sec inclusive. Further,the amplitude of the ultrasound vibration of the treatment section 9 bythe US signal is preferably larger than 0 μm and smaller than 200 μm.Note that when the frequency of the US signal is 47 kHz, at a vibrationspeed of 8 m/sec, the amplitude of the treatment section 9 is 60 μm, andat a vibration speed of 18 m/sec, the amplitude of the treatment section9 is 120 μm.

Operation of the Surgical Operation System

Next, with use of the flowchart of FIG. 8, an operation of the surgicaloperation system 1 will be described.

Step S10

When a treatment is started, the US signal main control section 51 cperforms feedback control of the US signal output section 50 so that theUS signal output becomes the US signal output corresponding to a setvalue of the setting section 18 a, based on the value detected by the USsignal voltage detection section 52 b of the US signal detection section52. Further, the HV signal main control section 61 c performs feedbackcontrol of the HV signal output section 60 so that the HV signal outputbecomes the HV signal output of the coagulation waveform correspondingto the set value of the setting section 19 a, based on the valuedetected by the HV signal current detection section 62 a of the HVsignal detection section 62.

Step S11

When the HV signal auxiliary control section 51 b senses that thetreatment section 9 separates from the tissue based on a change value(differential value) of the impedance of the US signal, for example,which is detected by the US signal detection section 62 (S11; Yes),processing from step S12 is performed.

Step S12

The HV signal auxiliary control section 51 b controls the HV signalrelay 69 into an OFF state (open state). The time period from detectionof the US signal until application of the HV signal to the treatmentsection 9 stops is 1 ms or less.

Here, the reason why it is sensed that the treatment section 9 separatesfrom the tissue based on the US signal is that especially in theprocessing of the tissue having much fat where a high-energy dischargeeasily occurs, the change of the HV signal is small even when thetreatment section 9 is in a non-contact state, as compared with the timeof a contact state, but the change of the US signal is large. Namely,the tissue having much fat has a high electric resistance, andtherefore, even in the non-contact state, a large change does not occurto the HV signal as compared with the time of the contact state.However, the US signal generates a large change when the non-contactstate is brought about as compared with the time of the contact state,because the mechanical load significantly decreases.

Note that the US signal for sensing that the treatment section 9separates from the tissue is not limited to the change value of theimpedance of the US signal, but may be US signals detected by variousconfigurations as will be described later.

Step S13

The HV signal auxiliary control section 51 b keeps the OFF state of theHV signal relay 69 until a predetermined HV signal output wait time THof, for example, 15 ms elapses (S13; No).

Step S14

After the predetermined HV signal output wait time TH elapses (S13;Yes), the HV signal auxiliary control section 51 b controls the HVsignal relay 69 to the ON state (continuity state). Namely, the HVsignal auxiliary control section 51 b controls the HV signal outputsection 60 to restart output of the HV signal which is stopped.

Subsequently, the process from S10 is repeated.

The treatment section 9 comes into the contact state with the tissue toperform the treatment again, even if the treatment section 9 temporarilyseparates from the tissue. In the surgical operation system 1, output ofthe HV signal is automatically restarted after the predetermined HVsignal output wait time TH elapses, and therefore, favorable operabilityis provided. Note that the HV signal output wait time TH is preferably 5ms to 50 ms, and especially preferably 10 ms to 20 ms. If the HV signaloutput wait time TH is within the above described range, a high-energydischarge does not occur, and no trouble occurs to the operation.

Step S19

Until the treatment is finished (S19; Yes), the processing from step S10is repeatedly performed.

As in the above description, the surgical operation system 1 includesthe exclusive HV signal auxiliary control section 51 b for performingcontrol that stops output of the HV signal at a high speed when thetreatment section 9 separates from the tissue.

In particular, in a laparoscopic surgical operation which hasincreasingly become prevalent in recent years, the probe needs to beoperated on tissue in an extremely limited movable range. The surgicaloperation system 1 can efficiently perform a treatment by the synergeticeffect of ultrasound vibration and a high-frequency current, andincludes the HV signal auxiliary control section 51 b which controls theHV signal output section 60 based on the US signal and has a responsetime shorter than the HV signal main control section 61C, and therefore,suppresses occurrence of a high-energy discharge even if the treatmentsection 9 separates from the tissue.

Therefore, there is no fear of deterioration of the treatment section 9being accelerated, and the treatment section 9 or the other treatmentinstruments and the like being damaged, due to occurrence of ahigh-energy discharge.

Namely, the surgical operation system 1 can perform bleeding stoppingprocessing while making an incision line in the pressing direction, bysimultaneously applying ultrasound vibration and a high-frequencycurrent to the treatment section, has no fear of occurrence of a sparkdischarge (high-energy discharge) with large energy, and has favorableoperability.

Next, configuration examples for use in high-speed control of thesurgical operation system 1 of the embodiment will be described.

Configuration 1

The HV signal auxiliary control section 51 b performs control based onan integrated value of the signals of a frequency band from thefundamental frequency to the frequency which is twice as high as thefundamental frequency, which are included in the US signal.

When the treatment section 9 is in contact with tissue, distortionoccurs to the current waveform of the US signal. Namely, as shown inFIG. 9, at a contact time, a larger number of high-frequency componentsare included in the US signal of a sine wave of a fundamental frequency(f0) that is a resonance frequency, as compared with a non-contact time.

Therefore, in particular, the intensities of the signals of thefrequency band from the fundamental frequency (f0) to a frequency (2f0)which is twice as high as the fundamental frequency are compared withthe intensities at the time of a contact state, and thereby, it can bedetermined that the treatment section 9 separates from the tissue.

The intensities of the signals of the frequency band (f0 to 2f0) fromthe fundamental frequency (f0) to the frequency (2f0) which is twice ashigh as the fundamental frequency are extracted from the US signal withuse of, for example, a band-pass filter.

Further, the HV signal auxiliary control section 51 b more preferablyperforms control based on the change speed of the signal intensity ofthe frequency band (f0to 2f0), that is, the differential value, becausehigher-speed control is enabled.

Configuration 2

The HV signal auxiliary control section 51 b performs control based onthe signals of the frequencies which are odd multiples of thefundamental frequency, which are included in the US signal.

As is already described, when the treatment section 9 is in contact withtissue, distortion occurs to the current waveform of the US signal. As aresult, as compared with the amplitude of the US signal at the time of anon-contact state as shown in FIG. 10A, the amplitude of the US signalat the time of a contact state shown in FIG. 10B increases especially inthe frequencies (3f0, 5f0 , , , ) which are odd multiples of thefundamental frequency (f0).

The amplitudes of the signal of a frequency (3f0) that is three times ashigh as the fundamental frequency (f0) and the US signal of a frequency(5f0) that is five times as high as the fundamental frequency (f0) areextracted from the US signal by a band-pass filter. From the viewpointof the intensities of the signals which can be extracted and the circuitmounting cost, signals of (3f0 and 5f0) are preferably extracted, butonly the signal of (3f0) may be extracted, or the signals of (3f0, 5f0,7 f0, . . . ) and the like may be extracted.

Further, the HV signal auxiliary control section 51 b more preferablyperform control based on the change speed, namely, the differentialvalue of the extracted signals, because higher-speed control is enabled.

Configuration 3

The HV signal auxiliary control section 51 b performs control based onthe phase difference between the voltage and the current of the USsignal.

The US signal of the US apparatus 5 is subjected to PLL control in thePLL section 57 of a secondary circuit via the output transformer 54 asshown in FIG. 11. Note that FIG. 11 shows only some of the components ofthe surgical operation system. Here, the output transformer 54 whichprovides insulation between a patient circuit and the secondary circuitis designed to be able to drive for a long period of time with themaximum current and the maximum voltage. Therefore, in the patientcircuit without the PLL section 57, the voltage of the US signal is avoltage much lower than the maximum voltage, when the treatment section9 is not in contact with tissue, namely, when the mechanical load (load)is small. As shown in FIG. 12, when the load is small, the phasedifference between the voltage and the current of the US signal islarge.

As shown in FIG. 11, by the US signal detection section 52 having the USsignal auxiliary detection section 52B which detects the US signal ofthe patient circuit, in addition to the US signal main detection section52A which detects the US signal of the secondary circuit, it can besensed that the treatment section 9 is brought into a non-contact statewith tissue, from the phase difference of the current and the voltage ofthe US signal of the patient circuit.

Further, the HV signal auxiliary control section 51 b more preferablyperforms control based on the change speed of the detected signal,namely, the differential value, because higher-speed control is enabled.

Configuration 4

The HV signal auxiliary control section 51 b performs control based onthe change speed of the resonance frequency of the US transducer.

The fundamental frequency of the US signal of the US apparatus 5 ischanged by the PLL section 27 in response to change of the resonancefrequency of the US transducer. The resonance frequency changes inresponse to contact/non-contact of the treatment section 9 with tissue,that is, the mechanical load of the treatment section 9. Here, theresonance frequency also changes in accordance with a temperature.Therefore, the US signal auxiliary detection section 52B detects thechange speed (differential value) of the resonance frequency, and the HVsignal auxiliary control section 51 b senses that the treatment section9 is brought into a non-contact state with the tissue by occurrence ofabrupt change of a predetermined value or more of the change speed.

Note that the configurations which can be used in the surgical operationsystem 1 are not limited to the configurations described above, andvarious configurations having similar effects can be used. Further, twoor more of the configurations may be used in combination. For example,the configuration 1 and the configuration 2 are used, and when the levelof the US signal of at least any one of the configurations becomes apredetermined value or more, the HV signal auxiliary control section 51b may stop output of the HV signal.

Modification of the First Embodiment

Next, a surgical operation system 1A of a modification of the firstembodiment will be described. Since the surgical operation system 1A ofthe present modification is analogous to the surgical operation system 1of the first embodiment as shown in FIG. 13, the components with thesame functions are assigned with the same reference signs, and thedescription thereof will be omitted.

The HV signal auxiliary control section 51 b of the surgical operationsystem 1A also performs control of stopping output of the US signalsimultaneously with control of stopping output of the HV signal, whenthe treatment section 9 separates from tissue.

In the US signal output section 50, a US signal relay 59 that is aswitch that turns on/off output of a signal received from the powersupply 58 to a post-stage circuit is placed. Namely, the US signal relay59 outputs the signal to the post-stage circuit in an ON state(continuity state), but does not output the signal to the post-stagecircuit in an OFF state (open state).

The HV signal auxiliary control section 51 b controls not only the HVsignal relay 69, but also the US signal relay 59. The surgical operationsystem 1A has the effect which the surgical operation system 1 has, andfurther can more reliably prevent occurrence of a high-energy discharge.Namely, the surgical operation system 1A is more favorable inoperability than the surgical operation system 1.

Note that the HV signal auxiliary control section 51 b preferablycontrols the US signal output section 50 to restart the output of the USsignal which is stopped after a predetermined US signal output wait timeperiod, in the same manner as the HV signal auxiliary control section 51b controls the HV signal output section 60 to restart the output of theHV signal which is stopped after the predetermined HV signal output waittime period.

Second embodiment

Next, a surgical operation system 101 of a modification of a secondembodiment will be described. Since the surgical operation system 101 isanalogous to the surgical operation system 1 of the first embodiment,the components with the same functions are assigned with the samereference signs, and the description thereof will be omitted.

With use of FIG. 14, a configuration of the surgical operation system101 will be described. As in the following description, the surgicaloperation system 101 includes a US signal auxiliary control section 61 bthat controls the US signal output section 50 based on an HV signal, andhas a response time shorter than the US signal main control section 51c.

The US apparatus 5 which generates a US signal and supplies ultrasound(US) energy to the treatment section 9 has the central processing unit(CPU) 51, the US signal detection section 52, the A/D conversion section53, the output transformer 54, the amplifier 55, the waveform generatingsection 56, the PLL section 57, the power supply 58 and the drive signalrelay (US signal relay) 59. The output transformer 54, the amplifier 55,the waveform generating section 56, the PLL section 57, the power supply58 and the US signal relay 59 configure the drive signal output section(US signal output section) 50. The US signal is an AC signal of a signwave of a predetermined fundamental frequency (resonance frequency), forexample.

The US signal relay 59 is an ON/OFF switch which shuts off output of thesignal received from the power supply 58 to the post-stage circuit.Namely, the US signal relay 59 outputs the signal to the post-stagecircuit in an ON state (continuity state), but does not output thesignal to the post-stage circuit in an OFF state (open state).

The CPU 61 which performs control of the entire HV apparatus 6 andcontrol of the US signal relay 59 has the high-frequency signalcalculating section (HV signal calculating section) 61 a, the drivesignal auxiliary control section (US signal auxiliary control section)61 b and the high-frequency signal main control section (HV signal maincontrol section) 61 c. Note that the HV signal calculating section 61 a,the US signal auxiliary control section 61 b and the HV signal maincontrol section 61 c may be respectively configured by different CPUs.Further, the CPU 61 may be the same CPU as the CPU 51.

Feedback control that is ordinary control performed by the US signalmain control section 61 c and the HV signal main control section 51 c iscontrol for keeping, for example, a signal intensity at a predeterminedintensity. In contrast with this, the US signal auxiliary controlsection 61 b controls the US signal relay 59 of the US signal outputsection 50 to an ON state or an OFF state, based on the HV signaldetected by the HV signal detection section 62. Namely, the controlwhich is performed by the US signal auxiliary control section 61 b isON/OFF control that only stops output of a signal, and therefore, canrelatively easily realize high-speed control with a short response time,as compared with the ordinary control that increases and decreasesoutput.

As already described, the treatment by the handpiece in which ultrasoundvibration and a high-frequency current are simultaneously applied to thetreatment section has the fear of occurrence of a spark discharge(hereinafter, called “high-energy discharge”) with large energy, whichhardly occurs in the treatment by the handpiece in which only ahigh-frequency current is applied to the treatment section.

For example, there is the fear that when the treatment section 9 comesin contact with another treatment instrument made of a metal or thelike, a high-energy discharge occurs, and the treatment section 9, theother treatment instrument or the like is damaged.

In the surgical operation system 101, when the US signal auxiliarycontrol section 61 b senses that the treatment section 9 comes incontact with another treatment instrument made of a metal, or the likebased on the HV signal detected by the HV signal detection section 62,the US signal auxiliary control section 61 b controls the US signalrelay 59 of the US signal output section 50 to an OFF state. Namely,after an extremely short time from detection of the HV signal, theultrasound vibration of the treatment section 9 stops. Therefore, evenif the treatment section 9 contacts another treatment instrument, ahigh-energy discharge does not occur.

It is conceivable that immediately before a high-energy dischargeoccurs, a discharge that has a small intensity, but differs from anordinary discharge occurs as a precursory phenomenon thereof. The USsignal auxiliary control section 61 b stops output before a high-energydischarge occurs based on the signal change due to the precursoryphenomenon or the like, and thereby prevents occurrence of thehigh-energy discharge.

Namely, in a strict sense, “when the treatment section 9 contacts themetallic instruments” does not mean “when the treatment section 9completely contacts”, but rather means “when the treatment section 9starts to contact”.

In addition, the US signal auxiliary control section 61 b has a responsetime shorter than the US signal main control section 61 c. Namely,response times of the US signal main control section Mc and the HVsignal main control section 61 c which perform feedback control arepreferably 5 ms (milliseconds) or longer, and, for example, 100 ms.

In contrast with this, the response time of the US signal auxiliarycontrol section 61 b is preferably 1 ms or shorter, and, for example,0.5 ms. Further, the US signal relay 59 is also a circuit of a simpleoperation that is an ON/Off operation, and therefore, a response timethereof is 1 ms or shorter, and is, for example, 0.2 ms. The US signalrelay 59 may be a mechanical type switch, or a semiconductor switch.

Note that if the response time is 1 ms or less, an attenuation sectionthat reduces signal output to substantially zero, namely, reduces asignal intensity to such an intensity that does not influence atreatment or the like may be used, in place of the relay type ON/OFFswitch. For example, when the amplifier 55 can be controlled at a highspeed, the function of the attenuation section may be realized bycontrol of the amplifier 55. Namely, in the following description andthe like, “stops signal output” is the concept also including the caseof “reducing signal output to substantially zero”.

Note that the HV signal detection section 62 detects signals atintervals of 1 ms or less. The US signal main control section 51 cprocesses the signals which the US signal detection section 52 detectsat intervals of 100 ms, for example.

The US signal auxiliary control section 61 b sequentially processes thesignals which the HV signal detection section 62 detects at intervals of1 ms or less, but the HV signal main control section 61 c processes thesignals which the HV signal detection section 62 detects atpredetermined intervals longer than the detection intervals of the HVsignal detection section 62, for example, at intervals of 100 ms. The HVsignal main control section 61 c may perform control with use of anintegrated value or a mean value of the signals which the HV signaldetection section 62 detects at intervals of 1 ms or less.

Note that as shown in FIG. 5, the HV signal detection section 62 mayhave an HV signal main detection section 62A and an HV signal auxiliarydetection section 62B. Further, the HV signals detected by the HV signalmain detection section 62A and the HV signals detected by the HV signalauxiliary detection section 62B may be sampled from the same spot on thecircuit, or may be sampled from different spots.

The HV signal auxiliary detection section 62B has the detectionintervals shorter than the HV signal main detection section 62A. Forexample, the HV signal main detection section 62A detects signals atintervals of 5 ms or more, for example, intervals of 100 ms, whereas theHV signal auxiliary detection section 62B detects signals at intervalsof 1 ms or less, for example, intervals of 0.5 ms.

Subsequently, the HV signal main control section 61 c performs ordinaryfeedback control based on the signals detected by the HV signal maindetection section 62A. Further, the US signal main control section 51 cperforms ordinary feedback control based on the signals which the USsignal main detection section 52A detects, and the US signal auxiliarycontrol section 61 b performs high-speed control with a high responsespeed based on the signals which the HV signal auxiliary detectionsection 62B detects.

The US signal main control section 51 c and the HV signal main controlsection 61 c can stably perform control if a loop processing time periodof detection/response is in the aforementioned range or more. Namely, ifthe detection interval and the response time are too short in control offeedback, signal output is sometimes excessively increased in responseto a noise signal which appears in a pulse form, for example. Therefore,the signal detection intervals and the response times of the US signalmain control section 51 c and the HV signal main control section 61 care preferably in the aforementioned range or more.

In contrast with this, the US signal auxiliary control section 61 bneeds to stop output of the HV signal, before a high-energy dischargeoccurs, when the treatment section 9 separates from tissue.

Therefore, the time period from detection of an HV signal until anoperation of the US signal relay 59 is completed by control of the USsignal auxiliary control section 61 b is preferably 1 ms or less.

If the time period is the above described time period or less,occurrence of a high-energy discharge can be reliably prevented.

Note that the above described detection intervals, the above describedresponse time and the time period until completion of the operation arepreferably short, but in the industrially available systems,approximately 1 μs (microsecond) is a lower limit value.

Operation of the Surgical Operation System

Next, with use of a flowchart of FIG. 15, an operation of the surgicaloperation system 101 will be described.

Step S110

Step S110 is the same as step S10 of FIG. 7.

Step S115

When the US signal auxiliary control section 61 b senses that that thetreatment section 9 contacts a metallic instrument based on, forexample, a differential value of the current of the HV signal (S115;Yes), processing from step S116 is performed.

Step S116

The US signal auxiliary control section 61 b stops the HV signal in 1 msor less from the HV signal detection.

The US signal auxiliary control section 61 b controls the US signalrelay 59 to an OFF state (open state). The time period from thedetection of the HV signal until stop of application of the US signal tothe ultrasound transducer 23 is 1 ms or less.

Here, the reason why it is sensed that the treatment section 9 contactsanother treatment instrument made of a metal, or the like based on theHV signal is that the change of the HV signal is larger than the changeof the US signal.

Note that the signal for sensing that the treatment section 9 contacts ametallic instrument is not limited to the differential value of thecurrent of the HV signal detected in the HV signal detection section 62,but may be HV signals detected by various configurations, as will bedescribed later.

Step S117

The US signal auxiliary control section 61 b keeps the OFF state of theUS signal relay 59 until a predetermined US signal output wait time TUof, for example, 150 ms elapses (S117; No).

Step S118

After the predetermined US signal output wait time TU elapses (S117;Yes), the US signal auxiliary control section 61 b controls the USsignal relay 59 to the ON state (continuity state). Namely, the USsignal auxiliary control section 61 b controls the US signal outputsection 50 to restart output of the US signal which is stopped.

Subsequently, the processing from S110 is repeated.

It is only for a short time that the treatment section 9 erroneouslycontacts the other treatment instrument made of a metal, or the like. Inthe surgical operation system 101, output of the US signal isautomatically restarted after the predetermined US signal output waittime TH elapses, and therefore, favorable operability is provided. Notethat the US signal output wait time TU is preferably 50 ms to 500 ms,and especially preferably 100 ms to 200 ms. If the US signal output waittime TU is within the above described range, a high-energy dischargedoes not occur, and no trouble occurs to the operation.

Step S119

Until the treatment is finished (S119; Yes), the processing from stepS110 is repeatedly performed.

As in the above description, the surgical operation system 101 includesthe exclusive US signal auxiliary control section 61 b for performingcontrol that stops output of the US signal at a high speed when thetreatment section 9 contacts a metallic instrument.

In particular, in a laparoscopic surgical operation which hasincreasingly become prevalent in recent years, the probe needs to beoperated on tissue that is held by a metallic forceps and a metallicclip in an extremely limited movable range. The surgical operationsystem 101 can efficiently perform a treatment by the synergetic effectof ultrasound vibration and a high-frequency current, and suppressesoccurrence of a high-energy discharge even if the treatment section 9contacts a metallic instrument.

Therefore, there is no fear that deterioration of the treatment section9 is accelerated, and the treatment section 9, another treatmentinstrument or the like is damaged, due to occurrence of a high-energydischarge. Therefore, the surgical operation system 101 has favorableoperability.

Next, configuration examples for use in high-speed control of thesurgical operation system 101 of the embodiment will be described.

Configuration 1

The US signal auxiliary control section 61 b performs control based onthe signals of frequencies higher than the fundamental frequency, whichare included in the HV signal.

When the treatment section 9 contacts a metallic instrument, theresistance becomes small, and therefore, a large current flows as the HVsignal. Even before the treatment section 9 completely contacts themetallic instrument, a very weak discharge occurs to the metallicinstrument from the treatment section 9. Thereupon, in the current ofthe HV signal including a sine wave of a predetermined fundamentalfrequency, for example, 350 kHz, the signals of frequencies higher thanthe fundamental frequency starts to be generated. In other words, thesignals of the frequencies higher than the fundamental frequency areincluded in the HV signal.

Therefore, it can be sensed that the treatment section 9 starts tocontact the metallic instrument by comparing the intensities of thesignals of the frequencies higher than the fundamental frequency, whichare included in the HV signal, with a predetermined value.

Further, the US signal auxiliary control section 61 b more preferablyperforms control based on the change speed of the intensities of thedetected signals, namely, a differential value, because control at ahigher speed is enabled.

Configuration 2

The US signal auxiliary control section 61 b performs control based onthe change speed of the root means square value of the HV signal.

When the treatment section 9 starts to contact a metallic instrument,the current value (root means square value) of the HV signal starts toincrease abruptly. When the current value of the HV signal increases toa predetermined value or more, a high energy discharge occurs. The USsignal auxiliary control section 61 b can stop the US signal before ahigh-energy discharge occurs, by performing control based on the changespeed of the current value (root means square value) of the HV signal,namely, the differential value.

Configuration 3

The US signal auxiliary control section 61 b performs control based onthe distortion component of the HV signal.

When the treatment section 9 contacts a metal instrument, the resistancebecomes small in the HV signal, and therefore, a large current flows.Thereupon, a distortion occurs to the current waveform of the HV signalof a predetermined fundamental frequency. The distortion of the HVsignal is detected, and thereby start of contact can be sensed.

Note that the magnitude of a distortion increases with increase ofspecific resistance of a matter that the treatment section 9 contacts.For example, when the treatment section 9 contacts fat tissue, adistortion also occurs, but the magnitude of the distortion is smallerthan when the treatment section 9 contacts lean meat tissue. Further,the magnitude of the distortion at the time of the treatment section 9contacting a metallic instrument is much larger than when the treatmentsection 9 contacts lean meat tissue. Therefore, the presentconfiguration is unlikely to cause an erroneous operation.

Note that the configurations that can be used in the surgical operationsystem 101 are not limited to the configurations described above, andvarious configurations that have similar effects can be used. Further,two or more configurations may be used in combination.

Modification 1 of the Second Embodiment

Next, a surgical operation system 101A of a modification 1 of the secondembodiment will be described. Since the surgical operation system 101Aof the present modification is analogous to the surgical operationsystem 101 of the second embodiment as shown in FIG. 16, the componentswith the same functions are assigned with the same reference signs, andthe description thereof will be omitted.

The US signal auxiliary control section 61 b of the surgical operationsystem 101A also performs control of stopping output of the HV signalsimultaneously with control of stopping output of the US signal, whenthe treatment section 9 contacts another instrument made of a metal.

In the HV signal output section 60, an HV signal relay 69 that is anOn/Off switch that shuts off output of a signal received from the powersupply 68 to a post-stage circuit is placed. Namely, the HV signal relay69 outputs the signal to the post-stage circuit in an ON state(continuity state), but does not output the signal to the post-stagecircuit in an OFF state (open state).

The US signal auxiliary control section 61 b controls not only the USsignal relay 59, but also the HV signal relay 69.

The surgical operation system 101A has the effect which the surgicaloperation system 101 has, and further can more reliably preventoccurrence of a high-energy discharge. Namely, the surgical operationsystem 101A is more favorable in operability than the surgical operationsystem 101.

Note that the US signal auxiliary control section 61 b preferablycontrols the HV signal output section 60 to restart output of the HVsignal which is stopped after a predetermined HV signal output wait timeperiod, in the same manner as the US signal auxiliary control section 61b controls the US signal output section 50 to restart output of the USsignal which is stopped, after the predetermined US signal output waittime period.

Third Embodiment

Next, a surgical operation system 201 of a modification of a thirdembodiment will be described. Since the surgical operation system 201 isanalogous to the surgical operation system 1 of the first embodiment andthe surgical operation system 101 of the second embodiment, thecomponents with the same functions are assigned with the same referencesigns, and the description thereof will be omitted.

Configuration of the Surgical Operation System

Next, a configuration of the surgical operation system 201 will bedescribed.

As shown in FIG. 17, the surgical operation system 201 has theconfiguration of the surgical operation system 1 and the configurationof the surgical operation system 101. Namely, the surgical operationsystem 201 includes the US signal auxiliary control section 61 b whichcontrols the US signal output section 50 based on the HV signal, and hasthe response time shorter than the US signal main control section 51 c,and the HV signal auxiliary control section 51 b which controls the HVsignal output section 60 based on the US signal, and has the responsetime shorter than the HV signal main control section 61C.

Operation of the Surgical Operation System

Next, with use of a flowchart of FIG. 18, an operation of the surgicaloperation system 201 will be described.

Step S210

When a treatment is started, the US signal main control section 51 cperforms feedback control of the US signal output section 50 so that theUS signal output becomes the US signal output corresponding to a setvalue of the setting section 18 a, based on the value detected by the USsignal voltage detection section 52 b of the US signal detection section52. Further, the HV signal main control section 61 c performs feedbackcontrol of the HV signal output section 60 so that the HV signal outputbecomes the HV signal output of the coagulation waveform correspondingto a set value of the setting section 19 a,based on the value detectedby the HV signal current detection section 62 a of the HV signaldetection section 62.

Note that when the treatment section 9 is in a non-contact state withthe organ such as a liver that is a parenchyma organ for which thetreatment section 9 performs treatment of “making an incision line”, atthe time of start of use, output of the HV signal is immediately stoppedby the processing from step S11 which will be described later.

Step S211

When the HV signal auxiliary control section 51 b senses that thetreatment section 9 separates from the tissue based on a change value(differential value) of the impedance of the US signal, for example,which is detected by the US signal detection section 62 (S211; Yes),processing from step S212 is performed.

Step 212

The HV signal auxiliary control section 51 b controls the HV signalrelay 69 to an OFF state (open state). The time period from detection ofthe US signal until application of the HV signal to the treatmentsection 9 stops is 1 ms or less.

Here, the reason why it is sensed that the treatment section 9 separatesfrom the tissue based on the US signal is that in the processing of thetissue having much fat where a high-energy discharge especially easilyoccurs, the change of the HV signal is small even when the treatmentsection 9 is in a non-contact state, as compared with when the treatmentsection 9 is in a contact state, but the change of the US signal islarge. Namely, the tissue having much fat has a high electricresistance, and therefore, even in the non-contact state, a large changedoes not occur to the HV signal as compared with the time of the contactstate. However, when the non-contact state is brought about, themechanical load of the US signal significantly decreases, and therefore,as compared with the time of the contact state, the US signal generatesa large change.

Note that the US signal for sensing that the treatment section 9separates from the tissue is not limited to the change value of theimpedance of the US signal, but may be US signals that are detected byvarious configurations as will be described later.

Step S213

The HV signal auxiliary control section 51 b keeps the OFF state of theHV signal relay 69 until a predetermined HV signal output wait time THof, for example, 15 ms elapses (S213; No).

Step S214

After the predetermined HV signal output wait time TH elapses (S213;Yes), the HV signal auxiliary control section 51 b controls the HVsignal relay 69 to the ON state (continuity state). Namely, the HVsignal auxiliary control section 51 b controls the HV signal outputsection 60 to restart output of the HV signal which is stopped.

Subsequently, the processing from S210 is repeated.

The treatment section 9 comes into the contact state with the tissue toperform the treatment again, even if the treatment section 9 temporarilyseparates from the tissue. In the surgical operation system 201, outputof the HV signal is automatically restarted after the predetermined HVsignal output wait time TH elapses, and therefore, favorable operabilityis provided. Note that the HV signal output wait time TH is preferably 5ms to 50 ms, and especially preferably 10 ms to 20 ms. If the HV signaloutput wait time TH is within the above described range, a high-energydischarge does not occur, and no trouble occurs to operation.

Step S215

When the US signal auxiliary control section 61 b senses that thetreatment section 9 contacts a metallic instrument based on, forexample, the differential value of the current of the HV signal (S15;Yes), processing from step S216 is performed.

Step S216

The US signal auxiliary control section 61 b stops the HV signal after 1ms or less from the HV signal detection.

The US signal auxiliary control section 61 b controls the US signalrelay 59 to an OFF state (open state). The time period from thedetection of the HV signal until stop of application of the US signal tothe ultrasound transducer 23 is 1 ms or less.

Here, the reason why it is sensed that the treatment section 9 contactsthe other metallic treatment instrument or the like based on the HVsignal is that the change of the HV signal is larger than the change ofthe US signal.

Note that the signal for sensing that the treatment section 9 contactsthe metallic instrument is not limited to the differential value of thecurrent of the HV signal detected in the HV signal detection section 62,but may be HV signals detected by various configurations as will bedescribed later.

Step S217

The US signal auxiliary control section 61 b keeps the OFF state of theUS signal relay 59 until a predetermined US signal output wait time TUof, for example, 150 ms elapses (S217; No).

Step S218

After the predetermined US signal output wait time TU elapses (S217;Yes), the US signal auxiliary control section 61 b controls the USsignal relay 59 to the ON state (continuity state). Namely, the USsignal auxiliary control section 61 b controls the US signal outputsection 50 to restart output of the US signal which is stopped.

Subsequently, the processing from S210 is repeated.

It is only for a short time that the treatment section 9 erroneouslycontacts another treatment instrument made of a metal, or the like. Inthe surgical operation system 201, output of the US signal isautomatically restarted after the predetermined US signal output waittime TH elapses, and therefore, favorable operability is provided. Notethat the US signal output wait time TU is preferably 50 ms to 500 ms,and especially preferably 100 ms to 200 ms. If the US signal output waittime TU is within the above described range, a high-energy dischargedoes not occur, and no trouble occurs to operation. Note that the reasonwhy the US signal output wait time TU is set to be longer than the HVsignal output wait time TH is that as compared with electric energy (HVsignal), mechanical energy (US signal) has a low effective responsespeed, and by stopping for a short time, a high-energy discharge isunlikely to be prevented. Namely, even when application of the US signalto the ultrasound transducer 23 is stopped, vibration of the treatmentsection 9 does not immediately stops.

Step S219

Until the treatment is finished (S219; Yes), the processing from stepS210 is repeatedly performed.

As in the above description, the surgical operation system 201 includesthe exclusive HV signal auxiliary control section 51 b for performingcontrol that stops output of the HV signal at a high speed when thetreatment section 9 separates from tissue, and the exclusive US signalauxiliary control section 61 b for performing control that stops outputof the US signal at a high speed when the treatment section 9 contacts ametallic instrument.

In particular, in a laparoscopic surgical operation which hasincreasingly become prevalent in recent years, the probe needs to beoperated on tissue that is held by a metallic forceps and a metallicclip in an extremely limited movable range. The surgical operationsystem 201 can efficiently perform a treatment by the synergetic effectof ultrasound vibration and a high-frequency current, and suppressesoccurrence of a high-energy discharge even if the treatment section 9separates from tissue, or the treatment section 9 contacts a metallicinstrument.

Therefore, there is no fear of deterioration of the treatment section 9being accelerated, and the treatment section 9, the other treatmentinstruments or the like being damaged, due to occurrence of ahigh-energy discharge. Therefore, the surgical operation system 201 hasfavorable operability.

Note that as the configuration examples of using the HV signal auxiliarycontrol section 51 b and the US signal auxiliary control section 61 b inhigh-speed control, the same configurations as the surgical operationsystem 1 or the surgical operation system 201 can be used.

Modification of the Third Embodiment

Next, a surgical operation system 201A of a modification of the thirdembodiment will be described. Since the surgical operation system 201Aof the present modification is analogous to the surgical operationsystem 201 of the third embodiment as shown in FIG. 19, the componentswith the same functions are assigned with the same reference signs, andthe description thereof will be omitted.

The HV signal auxiliary control section 51 b of the surgical operationsystem 201A also performs control that stops output of the US signalsimultaneously with control that stops output of the HV signal when thetreatment section 9 separates from tissue. Further, the US signalauxiliary control section 61 b of the surgical operation system 201Aalso performs control that stops output of the HV signal simultaneouslywith control that stops output of the US signal, when the treatmentsection 9 contacts another instrument made of a metal.

The HV signal auxiliary control section 51 b controls not only the HVsignal relay 69 but also the US signal relay 59. Further, the US signalauxiliary control section 61 b controls not only the US signal relay 59,but also the HV signal relay 69.

The surgical operation system 201A has the effect which the surgicaloperation system 201 has, and further can more reliably preventoccurrence of a high-energy discharge. Namely, the surgical operationsystem 201A is more favorable in operability than the surgical operationsystem 201.

Note that the HV signal auxiliary control section 51 b preferablycontrols the US signal output section 50 so as to restart the output ofthe US signal which is stopped after the predetermined US signal outputwait time period, in the same way as the HV signal auxiliary controlsection 51 b controls the HV signal output section 60 to restart outputof the HV signal which is stopped, after the predetermined HV signaloutput wait time period. Similarly, the US signal auxiliary controlsection 61 b preferably controls the HV signal output section 60 torestart the output of the HV signal which is stopped after thepredetermined HV signal output wait time period, in the same manner asthe US signal auxiliary control section 61 b controls the US signaloutput section 50 to restart the output of the US signal which isstopped, after the predetermined US signal output wait time period.

The present invention is not limited to the embodiments described above,and various modifications, alterations and the like can be made withinthe range without departing from the gist of the present invention.

The present application is based upon and claims the benefit of U.S.Patent Application Nos. 61/536,779 filed in the U.S.A. on Sep. 20, 2011,61/536,796 filed in the U.S.A. on Sep. 20, 2011, 61/536,818 filed in theU.S.A. on Sep. 20, 2011, the entire contents of which are incorporatedin the description, claims and drawings of the present application byreference.

What is claimed is:
 1. A method for incising a parenchyma organ with lowimpedance using a surgical operation system including a treatmentportion, the method comprising: simultaneously applying a high-frequencysignal and an ultrasound vibration to the treatment portion; bringingthe treatment portion close to the parenchyma organ; denaturing theparenchyma organ around the treatment portion into a coagulated tissuewith high impedance by the high-frequency signal, of the simultaneouslyapplied high-frequency signal and ultrasound vibration, of a coagulationwaveform applied to the treatment portion, the high-frequency signalbeing capable of causing moisture of the parenchyma organ to bevaporized but being incapable of causing the parenchyma organ to betranspired; causing a low impedance tissue to be exposed, by pressingthe treatment portion that performs ultrasound vibration, of thesimultaneously applied high-frequency signal and ultrasound vibration,to the coagulated tissue and exfoliating the coagulated tissue in apressing direction; and transpiring the low impedance tissue to incisethe low impedance tissue by generating a discharge between the lowimpedance tissue and the treatment portion by the high-frequency signal,of the simultaneously applied high-frequency signal and ultrasoundvibration, applied to the treatment portion.
 2. The method according toclaim 1, wherein at least the denaturing, the causing and thetranspiring are repeatedly performed in an order of the denaturing, thecausing and the transpiring.
 3. The method according to claim 2, whereinthe high-frequency signal having a crest factor of 5 or more.
 4. Themethod according to claim 2, wherein a vibration speed of the ultrasoundvibration of the treatment portion is 8 m/sec to 18 m/sec inclusive.